Addiction, social stigma and the barriers to recovery

A drug user is either a celebrity or a criminal, or that’s how much of the media see it. But such stereotypes make it harder for those recovering from addiction to seek help. The fear of being discovered as a past user excludes former addicts from work, housing and even friendship, says Leo Barasi

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Claire was
about to start at college when her counsellor recommended that she should not
tell anyone that she was being treated for drug dependence. So she spent months
leaving class early and making up excuses to sneak to the chemist to collect
her methadone prescription: lying to teachers, administrators and her friends.
Eventually, the pressure of the constant evasions became too much and she
dropped out of the course, rather than reveal her secret.

Claire’s
story is far from unusual. As her treatment counsellor had recognised,
suspicion, fear and distrust of people struggling with drug problems are
widespread. The result is that people with drug dependence, and their families,
are suffering in silence, missing opportunities for treatment, and prolonging
the process of recovery.

Research
by the UK Drug Policy Commission
(UKDPC) found these attitudes to be widespread, affecting those with drug
problems throughout their lives. We encountered people who felt trapped in
their homes because of the hostility they faced from neighbours. Being stuck
indoors, without social contacts or the opportunity to find work, may be one of
the hardest settings imaginable in which to fight drug dependence.

Everyday
prejudice creates a host of obstacles for recovering drug users. Offers of work
or housing are commonly withdrawn when it becomes known that the recipient has
had a serious drug problem, even if they have stopped using. Yet employment and
stable accommodation are two of the most important factors for helping people
overcome dependence and stay off drugs. Anything that makes these harder to
access will worsen drug problems.

Public
hostility can even make it harder for people with dependence problems to get
the treatment they need to help rebuild their lives. The fear of being exposed
as someone with a drug problem can deter them from going to a pharmacy to
collect prescriptions for methadone, for example, which could provide the
stability they need to stop using street drugs.

These
attitudes are not just those of an uneducated general public. Our research
found that many people with drug problems experience similar barriers in their
dealings with the professionals who should be helping them. Some find it
impossible to convince doctors or nurses that they need help, even when they
are in agonising pain or suffering from long-term conditions like Hepatitis C.
The suspicion of the medics is often that their patient is just looking for
drugs to relieve their cravings.

Others are
made to wait at pharmacies for as long as it takes to serve every other
customer in the store, including those who arrive after them. For recovering
drug users, treatment can mean daily visits to pharmacies. Such long waits can
make it impossible for them to be reliable in keeping other appointments, such
as work obligations or job interviews.

Disapproval

Such
problems are not just faced by those still using drugs. Even after they have
managed to overcome drug dependence, former drug users can face similar
hostility and distrust. The negative attitudes they face go beyond simple
disapproval. Disapproval is usually linked to a person’s behaviour, and so
disappears when that behaviour changes. Social disapproval of drug use even has
a useful role in dissuading some from engaging in potentially risky behaviour.

But
perceptions of people with drug problems go far beyond this. They are seen as
bearing a stigma, an enduring mark that defines them and which cannot be
removed by their stopping using street drugs. For many people with serious drug
problems, suffering not only from a debilitating health condition, but also
from social exclusion, the prospect of never being able to move past the label
of drug user or addict can be one more barrier to overcoming their dependence.

The
families of those with drug problems are also affected by this stigma. Such is
the fear of being associated with the shame of addiction, that family members
may avoid situations that could lead to their being identified as the relative
of a drug user, even at risk to their own well-being.

In our
research, we met Patricia, a mother who avoids contact with her old friends
because she is afraid they will mention her son’s drug dependence. We also
spoke to Tom, the brother of someone with a drug problem, who will not seek the
support he needs himself because he is worried others will find out and would
think less of him and his family.

Public
opinion on dependence and recovery suggests that this worry is not misplaced.
In one survey of public attitudes that UKDPC carried out, we found that, while
people want top-quality help to be made available to those recovering from
dependence, they are nevertheless suspicious and afraid of those who have had
drug problems.

More than
four in five agreed that people recovering from drug dependence should be part
of the normal community. But the public still wants to keep its distance, with
43 per cent of those asked saying they would not want to live next door to
someone who had been dependent on drugs. More than a third felt it would be
foolish to get into a serious relationship with someone who had suffered from
drug dependence, even if they appeared to be fully recovered.

Beating
stigma

To a
certain extent, these attitudes reflect how dependence is portrayed in the
media. People with drug addictions tend to labelled as “junkies” not as people
with a health problem that can be addressed. The term “addict” has itself
become pejorative and frames the issue in a particularly negative way.

If a media
story about a drug user is not about a celebrity, it is most likely to be about
a criminal, who, for example, has mugged someone or broken into a house in
order to pay for drugs. And if an article features someone who used to be
dependent on drugs but is now drug free or on medication, their previous
addiction is invariably mentioned, even when it has no relevance to the story.
The implication is that no one can truly move on from dependence.

But if television and newspapers can perpetuate attitudes that make recovery more difficult, changes in
how they report such stories could be similarly effective in making recovery
more achievable. A forthcoming guide for journalists and editors, produced by
the Society of Editors and UKDPC, will suggest ways to reframe news stories to
avoid the assumption that drug dependence is a life sentence.

But media
coverage cannot stray too far from where the public is. The stigma of drug
dependence will only be overcome if it is acknowledged and confronted directly.

There is a
parallel with attitudes to mental health. Public perceptions of those suffering
with mental illness have shifted over recent years. Nonetheless, it is still
less than a decade since the Sun newspaper ran a front-page story
about boxer Frank Bruno being taken to a psychiatric hospital under the
headline “Bonkers Bruno locked up”. The editor belatedly realised this was out
of step with British attitudes and later editions carried the headline “Sad
Bruno in mental home”. Even today, the Time
to Change campaign “Get Talking”, which aims to encourage debate about
mental health, demonstrates that shifting these views takes a lot of work over
a long period.

Attitudes
to those who suffer from drug dependence may lag behind perceptions of other
stigmatised groups. But the process has begun. Earlier this year, the Duchess
of Cambridge became a patron of the charity Action on Addiction and
said specifically that she wanted to break
the stigma associated with addiction, as Princess Diana had done with Aids.

UKDPC,
along with other organisations, is working on a project to determine practical
measures, such as the media guide, that can make recovery and inclusion
achievable for everyone.

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